New Therapies and Breakthroughs for Prostate Cancer

Prostate cancer is common, but not all prostate cancers are the same. Some people can live with prostate cancer for years without treatment. Others have an aggressive form that needs urgent treatment. There are still challenges in telling these groups apart. That’s why scientists are working on better diagnostic tools. And researchers are working on more precise therapies because prostate cancers shouldn't all be treated the same way. Let’s take a look at the latest breakthroughs in prostate cancer therapies.

What are some new diagnostic methods for prostate cancer?

Diagnosing prostate cancer isn’t easy. That’s because the major tools — the prostate-specific antigen test (PSA) and prostate biopsy — aren’t perfect. PSA levels can be high for reasons other than cancer, and they can be low even when someone has cancer. This makes it hard to know when someone needs a prostate biopsy. Some people end up getting prostate biopsies they don’t need, while others can get biopsies too late. Even when done perfectly, the biopsy can miss the cancer cells and delay a diagnosis.

Once someone has a diagnosis of prostate cancer, they’ll get a “risk class.” This risk class tries to predict how the cancer will behave over time. Teams usually pick treatments based on these risk classes. But the tools that help to assign a risk class aren’t perfect either.

Scientists are working to improve methods for diagnosis to overcome these limitations. The FDA hasn’t approved some of these methods yet, and your insurance may not cover them. But even so, they might be right for you:

• Prostate Health Index (PHI): This is a blood test using total PSA, free PSA, and p2PSA levels. A high PHI level is a better indicator of prostate cancer than a high PSA. A lower PHI level may be better for ruling out prostate cancer than PSA alone.

• 4Kscore test: This is a blood test that can determine your risk of developing aggressive prostate cancer. It’s only used for people without known prostate cancer. It can prevent treatment delays.

• SelectMDx: This is a urine test of two cancer-related biomarkers. This test is done if you have an abnormal PSA level and/or digital rectal examination (DRE). It can help you and your team decide if you need a prostate biopsy.

• ConfirmMDx: This test evaluates tissue that your doctor has already biopsied. If the biopsy didn’t show cancer cells, ConfirmMDx then tests the tissue. The test can show evidence of cancer that the biopsy missed. The goal is to limit the number of false-negative biopsies.

• Prostate cancer antigen 3 (PCA3): This is a urine test that helps determine if someone with a negative biopsy needs another biopsy.

• Stockholm3 test: This is a test to help determine the aggressiveness of prostate cancers. It combines 5 blood markers, more than 100 genetic markers, and other information. The test is helpful if your Gleason score is 7 or higher.

• Decipher risk score: This test evaluates tissue that your healthcare provider has already biopsied. It can help identify aggressive cancers that may metastasize. It can also help determine if someone will benefit from radiation after surgery. 

• OncotypeDx, Prolaris and Promark: These tests also evaluate tissue that your healthcare provider has already biopsied to determine if cancer is more aggressive and the risk of recurrence. 

• miR Sentinel Prostate Cancer Test: This is a urine test that can detect RNA molecules which are usually found with more aggressive forms of prostate cancer

What are some emerging therapies for prostate cancer?

Because prostate cancers can act so differently, they need different types of treatment. New research is focusing on precision medicine. The goal is to have tailored treatment for each person from the very beginning. Since there are so many different types of prostate cancer, precision medicine needs to cover a lot of bases. It’s important to remember that not all emerging therapies are right for everyone. And the FDA hasn’t approved some of these treatments yet. If you have advanced prostate cancer, talk to your team about whether you should try these emerging therapies:

• PARP inhibitors: These medications stop prostate cancers from growing. They can help people with metastatic prostate cancer who have mutations in their BRCA1, BRCA2, and DDR genes.

• Prostate membrane-specific antigen (PSMA) radionuclide therapy: PSMA radionuclide therapy delivers radiation directly to prostate cancer cells. A recent study showed that people with metastatic prostate cancer who received this therapy lived longer.

• Focal therapies: Focal therapies use heat, cold, or electricity to kill cancer cells in the prostate gland and limit damage surrounding tissues. Therapies include focal irreversible electroporation, high-intensity focused ultrasound, cryotherapy, and focal laser ablation. These therapies are still investigational (being researched).

• Immunotherapy: This uses your own immune system to help fight cancer. Cellular immunotherapy and checkpoint inhibitors are starting to show promise for prostate cancer. Checkpoint inhibitors work by turning on the immune cells that destroy cancer cells. Pembrolizumab (Keytruda) is an immune checkpoint inhibitor that works for certain people with metastatic hormone-resistant prostate cancer. Another medication, Sipuleucel-T, is a type of cellular immunity. It can help people with metastatic prostate cancer live longer.

New ways to diagnose and treat prostate cancer depend on clinical trials. Clinical trials are important to prove that tests and treatments work. Researchers present results from clinical trials to the FDA, and they inform national guidelines. A lot of people benefit from clinical trials, but trials wouldn’t be possible without volunteers.

Volunteering for a clinical trial is a big commitment, and there are pros and cons to think about. You need to be comfortable with getting an experimental therapy. The therapy may not work, and it could cause side effects. Participating in a clinical trial also takes time. You’ll need extra tests and visits with healthcare providers.

But clinical trials come with the benefit of getting a treatment that otherwise isn’t available. Usually these treatments cost much less (or are free). And of course — you’re helping many people by advancing science.

To participate in a clinical trial, you must meet certain criteria. You can find active clinical trials at clinicaltrials.gov. If you’re interested in a trial, talk to your team about whether you are a good candidate.

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Written by:

Jennifer Clements, MD, MSEd, NBHWC

Jennifer Clements, MD, MSEd, NBHWC, is a board-certified physician and health coach who is passionate about achieving optimal health through healthy lifestyles. Clements is a diplomate of the American Board of Obesity Medicine and the American Board of Integrative Medicine.

Edited by:

Samvida Patel, MNSP, INHC

Samvida Patel, MNSP, INHC, is a health editor at GoodRx. She is a nutritionist and integrative nutrition health coach with over 8 years of experience in health communications.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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